Tapia-Perez Jorge H, Zilke Robert, Schneider Thomas
Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany -
J Neurosurg Sci. 2016 Sep;60(3):301-12. Epub 2014 Dec 11.
We analyzed the relationship between statin continuation or discontinuation and outcome after spontaneous intracerebral hemorrhage (ICH).
From a databank with 447 data sets, we selected patients with hypertensive or anticoagulation-related hemorrhage (volume 10-250 mL). Of 323 patients available for analysis, 63 were taking statins. This group was divided into those who discontinued (N.=18) or continued therapy (N.=45). Statin users were matched by age, sex, and National Institutes of Health Stroke Scale (NIHSS) status in 1:4 ratio to nonusers. Mortality after 30 days, 3 months, and 12 months was analyzed using Cox regression. The Glasgow Outcome Scale (GOS) scores at discharge and at least 6 months after ICH onset were recorded.
Baseline characteristics of patients with continued and discontinued statin use were not different. Patients who discontinued statin therapy were very similar to their matched-cases; however, the control-matched cases for patients who continued statins had lower incidences of diabetes mellitus and cardiovascular diseases. In multivariate analysis, statin discontinuation was associated with a 6.9-fold (95% CI 2.09-23.13, P=0.002) higher risk of death within the first 30 days after ICH onset compared to patients who continued therapy. Patients who discontinued also had an increased risk of death within 30 days of ICH onset compared to their matched-controls (HR=3.87, 95% CI 1.69-8.87, P=0.001). The continued statin group displayed only a slight reduction in mortality risk after 3 month (HR=0.67, 95% CI 0.37-1.21, P=0.19) compared to matched-controls, but the chance to be discharge with a better neurological (NIHSS<15) was increased among patients with continued statin use (51% versus 33%, P=0.02).
The continued use of statins after an ICH led to a small mortality reduction, whereas discontinuing statins might be related to increased mortality. Randomized clinical trials are needed to define the role of statin use in the management of acute ICH.
我们分析了自发性脑出血（ICH）后他汀类药物的持续使用或停用与预后之间的关系。
从一个包含447个数据集的数据库中，我们选择了患有高血压或抗凝相关脑出血（出血量10 - 250 mL）的患者。在323例可供分析的患者中，63例正在服用他汀类药物。该组患者被分为停药组（n = 18）和继续治疗组（n = 45）。他汀类药物使用者按照年龄、性别和美国国立卫生研究院卒中量表（NIHSS）状态以1:4的比例与未使用者进行匹配。使用Cox回归分析30天、3个月和12个月后的死亡率。记录出院时以及脑出血发作后至少6个月时的格拉斯哥预后量表（GOS）评分。
他汀类药物持续使用组和停药组患者的基线特征无差异。停用他汀类药物治疗的患者与其匹配病例非常相似；然而，继续使用他汀类药物患者的匹配对照病例中糖尿病和心血管疾病的发生率较低。在多变量分析中，与继续治疗的患者相比，脑出血发作后前30天内，停用他汀类药物与死亡风险高6.9倍（95%可信区间2.09 - 23.13，P = 0.002）相关。与匹配对照相比，停用他汀类药物的患者在脑出血发作30天内死亡风险也增加（风险比=3.87，95%可信区间1.69 - 8.87，P = 0.001）。与匹配对照相比，继续使用他汀类药物组在3个月后死亡风险仅略有降低（风险比=0.67，95%可信区间0.37 - 1.21，P = 0.19），但继续使用他汀类药物的患者出院时神经功能较好（NIHSS<15）的机会增加（51%对33%，P = 0.02）。
脑出血后继续使用他汀类药物可使死亡率略有降低，而停用他汀类药物可能与死亡率增加有关。需要进行随机临床试验来确定他汀类药物在急性脑出血管理中的作用。
